Healthcare Provider Details

I. General information

NPI: 1912996315
Provider Name (Legal Business Name): BEVERLY GERARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S MAIN ST
CLAYTON GA
30525-5480
US

IV. Provider business mailing address

703 LANCELOT LOOP
CLAYTON GA
30525-5504
US

V. Phone/Fax

Practice location:
  • Phone: 706-782-1300
  • Fax: 706-223-6790
Mailing address:
  • Phone: 706-658-9032
  • Fax: 706-223-6790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number73437
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: